Flex Time Agreement

Flex Time Agreement

Employee Name*

Employee E-Mail Address*

Flex Time Start Date*

Flex Time End Date*

Request:*

Select

Below is the agreed upon work schedule for the time period inserted above.

If the dropdown list does not contain the time that you intent to begin/end, you may type in the time manually.

Monday

Begin Time*

Select or enter value

End Time*

Select or enter value

Tuesday

Begin Time*

Select or enter value

End Time*

Select or enter value

Wednesday

Begin Time*

Select or enter value

End Time*

Select or enter value

Thursday

Begin Time*

Select or enter value

End Time*

Select or enter value

Friday

Begin Time*

Select or enter value

End Time*

Select or enter value

Total Hours to be Worked*

Agreed Upon Lunch Period*

30 Minutes

1 Hour

Additional Comments

Supervisor Name*

Supervisor E-Mail Address*

By checking the box below, I acknowledge that I have read and understood the Flextime Policy, and agree to abide by its rules. I also understand that this Flextime Agreement is not an employment contract or an employment benefit. This agreement is being entered into by me voluntarily, and may be terminated by my supervisor at any time, for any reason.*

Send me a copy of my responses

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